“Eating disorders are often related to a need for control — something many young people feel they have lost during the pandemic,” said Karen Street, a consultant pediatrician at Royal Devon and Exeter Hospital and an officer for child mental health at the RCPCH, in a news release.
In a survey of more than 40 pediatricians and specialists in England, health-care providers reported a doubling, tripling or quadrupling of patients with food restriction disorders compared to last year, according to RCPCH. Centers that specialize in treating adolescents with eating disorders reported long waiting lists and a scarcity of spare beds for inpatient treatment. Pediatricians said they are often seeing children brought in with very progressed diseases, probably because of limited in-person interactions with friends, teachers or doctors who before the pandemic may have noticed changes earlier.
“Young people are also reaching us much sicker than they were before, and this is almost certainly because they are having less face-to-face interaction with general practitioners,” Street said. “GPs can’t see, or weigh, them during a telephone consultation, so by the time they arrive to us they are in worse shape.
“When lockdown disappears, the problem will remain,” she said. “The pandemic has potentially created a large number of eating disorders that will take two to three years to recover.”
RCPCH has warned parents to be on the lookout for signs of restrictive or disordered eating diseases such as anorexia, bulimia and binge eating. Possible signs of illness include cutting food into small pieces, going to the bathroom or to shower immediately after meals, eating very fast or hiding how much was eaten, significant weight loss, avoiding meals with others, sudden changes in diet, and obsessive exercise. Eating disorders can also be associated with other mental health issues, like depression, anxiety and addiction.
While young people are less likely to fall seriously ill from covid-19, Street told The Washington Post that a rise in eating disorders like anorexia during the pandemic could ultimately contribute to increased deaths in the general population. About 10 percent of those who develop anorexia are likely to die younger than average because of the disease’s toll on the body, she said.
Specialist centers for adolescents with eating disorders in the United Kingdom have largely remained open during lockdowns. But, Street said, pre-pandemic they were already overstretched by a gradual increase in patients — and now they require more funding from the government to meet needs as cases surge.
Street said her center had seen a significant increase in two patient profiles. “The first is high-achieving young girls who are really driven, with a carefully mapped future that has been taken away, along with extracurriculars,” she said in the news release. “The second group includes those with personality disorders and problems with emotional regulation … They just don’t know how to cope and have stopped eating entirely, leading to several urgent admissions.”
While eating disorders are more common among girls, Street said there has been a smaller increase in “muscle-orientated body image disorder” among young boys.
Luci Etheridge, a pediatrician specializing in eating disorders at St. George’s Hospital in London, reported to RCPCH a 250 percent increase in cases compared with 2019, with a particular spike in September. Previously, the center had been able to access referrals within a nationally mandated four-week window; now they have 30 children on the waiting list to be assessed.
“Many of these children are deteriorating on the waiting list,” Etheridge said. “The difficulties caused by lockdown and the loss of school are a universal part of the narrative in new presentations. It is common for young people to talk about anxiety increasing with the loss of school and worry about inactivity, often leading to a change in eating and exercise, which has played a part in precipitating an eating disorder.”
Jon Rabbs, a consultant pediatrician in Sussex, told RCPCH his eating disorder service usually saw 11 referrals a month. Since September, it has risen to around 100 monthly.
In Wales, Louise Phillips, a consultant pediatrician at Glan Clwyd Hospital, said part of her facility’s treatment involved removing applications, such as calorie counters, from a patient’s phone.
“Technology, in general, may account for part of the trend, in that screen time is much higher under lockdown, and young people have far less to focus on,” she said in RCPCH’s news release. “Physical exercise has also been encouraged and for some this will have become very obsessive and driven.”
Studies on the prevalence of eating disorders during the pandemic remain limited, but anecdotal evidence coupled with what is known about these diseases points to increasing cases in other communities and age groups.
In the United States, about 9 percent of population, or 28.8 million people, are estimated to have an eating disorder at some point in their life. Amid increased isolation, a loss of routine, and uncertainty over incomes, futures and daily needs like groceries, the National Eating Disorders Association (NEDA) has seen a marked increase in people looking for support during the pandemic: Just in November, it had a 72 percent increase in online chats and a 10 percent rise in calls compared with last year.
In a report released earlier this month, the Canadian Center for Mental Health and Sport (CCMHS) said that since the pandemic began it had recorded increased cases of eating disorders among Olympic and Paralympic athletes.
Holidays can be a particularly triggering time for food-related illnesses among all populations. As the British government considers whether to reopen schools after the new year, Street said increases in eating disorders were “one of many reasons why we [RCPCH] feel that children going back to school should be prioritized.”
To reach the National Eating Disorders Association’s helpline, call or text 800-931-2237. More information about support, resources and treatment options can be found at nationaleatingdisorders.org.